NJ Program Aims to Keep Seniors Out of Nursing Homes

A New Jersey healthcare program known as Global Options, which helps seniors age in place rather than nursing homes, is earmarked for a big boost in funding under Gov. Chris Christie’s proposed 2013 budget.

It’s part of the sweeping changes in long-term care underway in New Jersey, a topic that drew 19,000 senior citizens via telephone and the Internet to a virtual town hall last week with State Health Commissioner Mary E. O’Dowd and Human Service Commissioner Jennifer Velez.

New Jersey is moving forward with its push to help seniors remain in their homes and communities and avoid nursing homes for as long as possible.

While the majority of the state’s Medicaid long-term care spending still pays for nursing home care, the shift to home and community-based services is evidenced by the growth of Global Options, a major state program that provides nursing-home eligible Medicaid recipients with home-based support services like visiting nurses and housekeeping aides.

Christie has proposed $280 million for Global Options, compared to the $30 million that the state spent on home and community-based service for the elderly in 2007, O’Dowd told seniors listening in on the teleconference.

Rebalancing long-term care, to emphasize home versus institutional care, is at the center of plans for the state’s four Medicaid managed-care companies to deliver all Medicaid services to long-term care beneficiaries, including the 28,000 Medicaid recipients who now reside in nursing homes.

The shift of the long-term care population to managed care, scheduled for Jan. 1, 2013, is part of the state’s application for federal permission for changes to Medicaid, outlined in a document known as the state’s comprehensive Medicaid waiver. The waiver proposes numerous changes in how the state delivers services to its 1.3 million Medicaid members, ranging from coordinating their physical and mental health services to reducing excessive use of hospital emergency rooms.

New Jersey submitted the comprehensive waiver to the federal government in September, and is still waiting for a decision. The state’s $11 billion a year Medicaid program gets 50 percent of that money from the federal government, and the waiver has to be approved by the Centers for Medicare and Medicaid Services (CMS), part of the federal Department of Health and Human Services.

Asked how the negotiations with CMS were going, Velez said she has been assured the decision will come down soon. “We are told very shortly,” Velez said. “We’ve been talking to CMS every day.”

New Jersey has “put a lot in that waiver application,” Velez said, adding CMS officials have told her the waiver “is very unique compared to other states.”

There is a federal mandate that waivers be revenue neutral, meaning they can’t require additional federal spending. “We know it’s a process. We have to get these special terms and conditions reviewed, and it takes time,” Velez said. “CMS has to make some policy decisions, and I’ve been careful not to presuppose any CMS decisions, but this has been a very constructive partnership.”

Paul Langevin, president of the Health Care Association of New Jersey, whose members are the state’s nursing homes, said he agreed that New Jersey should strive to help seniors age in place, at homes and in their communities. But Langevin insists that unless the Christie administration and the legislature increase funding for nursing homes, there will be bankruptcies and shutdowns over the next year.

Langevin argues that efforts to help seniors stay in their homes for as long as possible mean that nursing homes are caring for older and sicker patients -- and thus will need more money, not less, in the years ahead.

Nursing home rates were reduced in the current fiscal year, and Langevin said the $5 million increase proposed by the Christie budget in 2013, which will be matched by $5 million in federal funds, is not adequate. Instead, he is advocating for a $30 million increase in 2013, which comes to $60 million with the federal match. “Nursing homes cannot survive entry into a managed care environment in a severely weakened financial state,” Langevin said.

Doug Johnston, government affairs manager for AARP New Jersey, said seniors have made it clear they want to avoid nursing homes. “When we survey AARP members, 92 percent tell us they want to stay in their homes, in their communities, close to their families, for as long as possible,” he said. “Nursing homes are a critical part of our healthcare structure, but most people want those services that can help them with their activities of daily living so they can stay in their homes.”

Langevin said he doesn’t want to go a nursing home either, but for patients who need 24 hour care, and particularly for those suffering from dementia, there is no alternative. And he argued that if the state does manage to keep seniors in their homes longer, patients will arrive at nursing homes “later in their life, they will arrive sicker and they probably won’t stay as long, but we are still going to need nursing care because these is no substitute for a nursing facility once you get to a certain point.”

During the AARP virtual town hall meeting, Velez said the comprehensive waiver would largely eliminate the bureaucratic barriers that now prevent seniors from getting all the services they need to age in place. For example, a senior who needs private duty nursing may not be able to get it, because of the complex rules that currently govern the state’s fragmented waiver system.

“We need a comprehensive wavier so that you are assessed for what you need, and under Medicaid you are able to get what you need,” Velez. The impact of the wavier will be to stretch Medicaid dollars further because “this allows us to gain access to developing more home and community-based services, which often are less expensive” than nursing homes. Seniors may need only “a little bit of assistance to stay at home in the community.”

During the teleconference, AARP asked seniors to respond to several poll questions. Among the responses: 44 percent know someone who is struggling to find assistance so they can remain in their homes; 54 percent know someone who is having difficulty putting food on the table, and 53 percent believe there is a stigma associated with receiving state assistance.
“There should not be a stigma,” associated with accepting government help, O’Dowd said. “So many of need help in our lives. We should not be embarrassed to ask for that help, and we should it accept it because that is why we are all here as a community -- to help one another.”